Provider Demographics
NPI:1669913554
Name:COLORADO STATE UNIVERSITY
Entity type:Organization
Organization Name:COLORADO STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SENG
Authorized Official - Suffix:
Authorized Official - Credentials:M S
Authorized Official - Phone:970-491-5991
Mailing Address - Street 1:1570 CAMPUS DELIVERY
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80523-1570
Mailing Address - Country:US
Mailing Address - Phone:970-491-5991
Mailing Address - Fax:
Practice Address - Street 1:502 W LAKE ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-0001
Practice Address - Country:US
Practice Address - Phone:970-491-5991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health